Post Traumatic Stress / Trauma

Trauma is an event that severely threatens our physical survival or safety or our emotional and psychological integrity and safety. A trauma is an event that frightens or shocks us, endangers our long-term well-being, causes us to fear for our life, safety, or sanity, or causes deep emotional pain, confusion, or fear. Trauma probably affects most people at some point in our lives – we may have a car accident, suddenly lose a loved-one to death, experience a criminal act (armed robbery, sexual assault, etc) be subject to serious emotional or physical abuse, live or serve in a place where war or terrorism occur, or in some other way be subject to intense fear, either for a moment or for a long period. Some people experience repeated trauma (such as victims of repeated abuse as a child, people who live in war zones, etc). Some psychologists consider birth to be a traumatizing experience. Many people recover from trauma through the support of family and friends and bouce back with great resiliency. For others, the recovery process is a longer journey and for some, the support, guidance, and assistance of professionals is fundamental to their healing.

• Psychotherapy for Trauma
• DSM Definition of Post Traumatic Stress Disorder
• PTSD After Fighting in Iraq - Case Example
• EMDR for Trauma -  Case Example
• Resources Related to Post Traumatic Stress / Trauma

This is a clip from an educational DVD called, "Making Peace With Chronic PTSD: Marla's Story." It takes a fascinating look into chronic PTSD with trauma expert, Frank Ochberg M.D., once the Associate Director for the NIMH, and Dr. Marla Handy, a former university lecturer with a difficult history of chronic PTSD as a result of childhood abuse and sexual trauma. This DVD is being used for counseling education, and by clinicians, social workers, educators, and trauma survivors. You can buy the full DVD from Gift From Within, a non-profit organization for survivors of trauma and victimization. Video clip and DVD copyright Gift From Within. Video clip used by special permission for GoodTherapy.org from Gift From Within.

Psychotherapy for Trauma

The best chance of recovering quickly from trauma is to address it in the immediate aftermath. Crisis debriefing, or Critical Incident Stress Debriefing, is a form of very short-term therapy or counseling that helps people make sense of their experience and feelings, plan to cope and stay safe, and connect with resources that can help them. If you experience trauma, talking about it with a professional as soon as possible can help diminish the chances of lasting ill-affects.

However, sometimes trauma does lead to long-term difficulties. The painful or frightening event may be replayed in memories, daydreams, and nightmares. We may avoid situations or people that remind us of the trauma. We may be emotionally numb, depressed, or anxious. Sometimes, people turn to drugs to numb feelings of terror that last for weeks, months, and in some cases, years after a trauma. If you experience such feelings, thoughts, or behaviors after a trauma, know that such experiences are very human and nothing to be ashamed of.  Trauma is more and more common in the United States military due to the current military engagements, and many soldiers seek help to deal with thoughts and feelings that result in being injured, watching fellow soldiers be injured or killed, killing opposing soldiers, or simply from experiencing the intense danger of war. Through the assistance of a trained professional, one can heal from the consequences of a trauma even long after the traumatic event. ~ Content edited by Susanne Dillmann

DSM Definition of Post Traumatic Stress Disorder

Post Traumatic Stress Disorder is diagnosed in certain cases. The following is the 309.81 DSM-IV Criteria for Posttraumatic Stress Disorder:

A. The person has been exposed to a traumatic event in which both of the following have been present:

(1) the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others

(2) the person's response involved intense fear, helplessness, or horror. Note: In children, this may be expressed instead by disorganized or agitated behavior.

B. The traumatic event is persistently reexperienced in one (or more) of the following ways:

(1) recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions. Note: In young children, repetitive play may occur in which themes or aspects of the trauma are expressed.

(2) recurrent distressing dreams of the event. Note: In children, there may be frightening dreams without recognizable content.

(3) acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur upon awakening or when intoxicated). Note: In young children, trauma-specific reenactment may occur.

(4) intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.

(5) physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.

C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following:

(1) efforts to avoid thoughts, feelings, or conversations associated with the trauma

(2) efforts to avoid activities, places, or people that arouse recollections of the trauma

(3) inability to recall an important aspect of the trauma

(4) markedly diminished interest or participation in significant activities

(5) feeling of detachment or estrangement from others

(6) restricted range of affect (e.g., unable to have loving feelings)

(7) sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or a normal life span)

D. Persistent symptoms of increased arousal (not present before the trauma), as indicated by two (or more) of the following:

• difficulty falling or staying asleep

• irritability or outbursts of anger

• difficulty concentrating

• hypervigilance

• exaggerated startle response

E. Duration of the disturbance (symptoms in Criteria B, C, and D) is more than one month.

F. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Acute: if duration of symptoms is less than 3 months 
Chronic: if duration of symptoms is 3 months or more
With Delayed Onset: if onset of symptoms is at least 6 months after the stressor

PTSD After Fighting in Iraq - Case Example

Ricky, 24, has recently returned from Iraq where he saw combat. He says he was doing fine until last week, when a robbery occurred in a local store while he was there. Suddenly, memories of combat flooded his senses, and he was paralyzed by them. Now he has nightmares about Iraq, but images of home get “mixed up in there.” Not only does Ricky feel overwhelmed and anxious about these flashbacks, he feels guilty for surviving while two of his friends did not, and guilty for not stopping the robbery at home. Talking about his feelings helps somewhat; focusing on ways to stay safe helps as well. Ricky’s guilt is addressed by exploring the choices Ricky has made and their motivations. Ricky’s beliefs about what it means to be a man, and his high expectations of himself are also explored. The therapist helps Ricky make peace with his own mortality, and teaches Ricky relaxation skills. Ricky asks for a psychiatric referral, and takes anti-anxiety medications to sleep a few times a week. He is also referred to a support group. A year after his first visit, he is no longer taking medications, and is feeling more hopeful, though he still struggles at times with intense grief about the war.

EMDR for Trauma -  Case Example

Patricia, 39, is a highly anxious person. A full history reveals severe abuse as a child, which Patricia is reluctant to revisit. The therapist allows several sessions to go by before bringing it up again, and when she does, Patricia becomes very upset and angry. Patricia finally agrees that her reaction indicates the abuse is still “dogging” her, and she agrees to a referral for EMDR. The EMDR process helps her being a real recovery from the abuse, and her anxiety diminishes considerably.

Resources Related to Post Traumatic Stress / Trauma:

Gift From Within - "Helping Traumatized Children at School" by Kathleen Nader, D.S.W.

The Trauma and Attachment Report - Written by Dr. Robert Muller, this blog is oriented toward making the difficult topic of interpersonal trauma interesting and accessible to both therapists and the general public.

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